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<html>
<head>
    <meta charset="UTF-8" />
    <meta name="viewport" content="width=device-width" />
    <style type="text/css">
        *{
        margin:0;
        padding:0;
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        body, html {
        margin:0;
        padding:0;
        font-family: "Helvetica Neue", HelveticaNeue, "Helvetica-Neue", Helvetica, "BBAlpha Sans", sans-serif;
        font-size: 12px;
        font-weight: normal;
        color: #222;
        background:#fdfdfd;
        /*width: 100%;*/
        height: 100%;
        }
        .wrapper {
        min-height:100%;
        position:relative;
        }
        .content {
        padding-bottom: 50px;
        padding-top: 5px;
        }
        .contentLayout {
        overflow: hidden;
        width: 870px;
        margin: 0 auto;
        }
        .contentLayout li {
        float: left;
        list-style: none;
        }
        .leftSide {
        padding: 0 10px;
        }

        table tr td {
        padding: 5px;
        }

        .leftSide table tr td div {
        width: 300px;
        height: 180px;
        border: 1px solid #9a9a9a;
        background: #fff;
        }
        .rightSide {
        width: 500px;
        padding:0 10px;
        }
        .rightSide table {
        width: 100%;
        }
        .advertisingBanner {
        width:100%;
        height:350px;
        background:#fff;
        border:1px solid #9a9a9a;
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        #languageList {
        padding:7px;
        background:#efefef;
        width: 100%;
        font-size:25px;
        border: 1px solid #9a9a9a;
        margin-top: 30px;
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        .header {
        height:150px;
        border-bottom:1px solid #9a9a9a;
        background:#6EDE28;
        }
        .header span {
        line-height: 40px;
        color: #fff;
        font-size: 18px;
        font-weight: bold;
        padding-left: 10px;
        }

        p.message {
        text-align: center;
        font-size:20px;
        }
        .footer {
        /*height: 30px;*/
        width: 100%;
        position: absolute;
        bottom: 0px;
        background:#303030;
        border-top:3px solid #1c94c4;
        color: #fff;
        text-align: center;
        padding: 5px 0;
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        .navigationLinks{
        list-style: none;
        padding: 0;
        margin: 6px 0;
        text-align: center;/*make this change*/
        }
        .navigationLinks li{
        float: none;/*make this change*/
        display:inline;/*make this change*/
        margin: 0 3px;
        }
        .navigationLinks li a{
        color:#ccc;
        text-decoration:none;
        font-size:13px;
        display:inline-block;/*make this change*/
        }
        .navigationLinks li a:hover{
        color:#fff;
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        .errorMsg{
        text-align:center;
        width:500px;
        font-family: Trebuchet MS,Tahoma,Verdana,Arial,sans-serif;
        font-size: 1.8em;
        margin:150px auto;
        }

        /* Form Elements */
        .rightSide form p {
            margin: 11px 0;
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        label {
            width:100px;
            float:left;
            margin-top: 7px;
            /*line-height: 30px;*/
        }
        form {
            /*margin-top:10px;*/
        }
        #registerForm input[type=text] {
            width: 220px;
            padding: 6px;
            color: #949494;
            font-family: Arial, Verdana, Helvetica, sans-serif;
            font-size: 12px;
            border: 1px solid #cecece;
        }
        select {
            width: 234px;
            padding: 6px;
            color: #949494;
            font-family: Arial, Verdana, Helvetica, sans-serif;
            font-size: 12px;
            border: 1px solid #cecece;
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        .whyTitle {
            margin-bottom:2px;
        }
        textarea {
            width:340px;
            height:100px;
            padding: 6px;
            color: #949494;
            font-family: Arial, Verdana, Helvetica, sans-serif;
            font-size: 12px;
            border: 1px solid #cecece;
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        .step {
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            font: 12px verdana;
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            -opera-border-radius: 3px;
            -webkit-border-radius: 3px;
            border-radius: 3px;
            padding: 10px 20px;
            background:#fff;
        }
        legend {
            font-size: 15px;
        }

        #registerForm input.error {
            border-color: #e77776;
            background: #f8dbdb;
        }
        span.error {
            font-size: 9px;
            color: #e77776;
            font-style: italic;
        }
        #agree.error {
            background: #f8dbdb;
        }
        #submitBtn {
            padding: 3px 15px;
        }
    </style>
</head>
<body>
<div class="wrapper">
    <div class="header">
        <span>1350 x 150</span>
    </div>
    <div class="content">
        <ul class="contentLayout">
            <li>
                <div class="leftSide">
                    <table>
                        <tr>
                            <td>
                                <div><p class="message">Video or JPEG</p></div>
                            </td>
                        </tr>
                        <tr>
                            <td>
                                <div><p class="message">Video or JPEG</p></div>
                            </td>
                        </tr>
                        <tr>
                            <td>
                                <div><p class="message">Video or JPEG</p></div>
                            </td>
                        </tr>
                    </table>
                </div>
            </li>
            <li>
                <div class="rightSide">
                    <table>
                        <tr>
                            <td>
                                <form id="registerForm" method='post' action="register.php">
                                <fieldset class="step">
                                <legend>Tell us about yourself</legend>
                                <p>
                                    <label>First Name:</label>
                                    <input type='text' name='firstname' id="firstname"/>
                                    <span id="fnameInfo"></span>
                                </p>
                                <p>
                                    <label>Last Name:</label>
                                    <input type='text' name='lastname' id="lastname" />
                                    <span id="lnameInfo"></span>
                                </p>
                                <p>
                                    <label>City:</label>
                                    <input type='text' name='city' id="city" />
                                    <span id="cityInfo"></span>
                                </p>
                                <p>
                                <label>Country:</label>
                                <select name="country">
                                <option value="CA">Canada</option>
                                <option value="US">United States of America</option>
                                <option value="GB">United Kingdom</option>
                                <option value="MX">Mexico</option>
                                <option>-------------------------------</option>
                                <option value="AF">Afghanistan</option>
                                <option value="AL">Albania</option>
                                <option value="DZ">Algeria</option>
                                <option value="AS">American Samoa</option>
                                <option value="AD">Andorra</option>
                                <option value="AG">Angola</option>
                                <option value="AI">Anguilla</option>
                                <option value="AG">Antigua &amp; Barbuda</option>
                                <option value="AR">Argentina</option>
                                <option value="AA">Armenia</option>
                                <option value="AW">Aruba</option>
                                <option value="AU">Australia</option>
                                <option value="AT">Austria</option>
                                <option value="AZ">Azerbaijan</option>
                                <option value="BS">Bahamas</option>
                                <option value="BH">Bahrain</option>
                                <option value="BD">Bangladesh</option>
                                <option value="BB">Barbados</option>
                                <option value="BY">Belarus</option>
                                <option value="BE">Belgium</option>
                                <option value="BZ">Belize</option>
                                <option value="BJ">Benin</option>
                                <option value="BM">Bermuda</option>
                                <option value="BT">Bhutan</option>
                                <option value="BO">Bolivia</option>
                                <option value="BL">Bonaire</option>
                                <option value="BA">Bosnia &amp; Herzegovina</option>
                                <option value="BW">Botswana</option>
                                <option value="BR">Brazil</option>
                                <option value="BC">British Indian Ocean Ter</option>
                                <option value="BN">Brunei</option>
                                <option value="BG">Bulgaria</option>
                                <option value="BF">Burkina Faso</option>
                                <option value="BI">Burundi</option>
                                <option value="KH">Cambodia</option>
                                <option value="CM">Cameroon</option>
                                <option value="IC">Canary Islands</option>
                                <option value="CV">Cape Verde</option>
                                <option value="KY">Cayman Islands</option>
                                <option value="CF">Central African Republic</option>
                                <option value="TD">Chad</option>
                                <option value="CD">Channel Islands</option>
                                <option value="CL">Chile</option>
                                <option value="CN">China</option>
                                <option value="CI">Christmas Island</option>
                                <option value="CS">Cocos Island</option>
                                <option value="CO">Colombia</option>
                                <option value="CC">Comoros</option>
                                <option value="CG">Congo</option>
                                <option value="CK">Cook Islands</option>
                                <option value="CR">Costa Rica</option>
                                <option value="CT">Cote D'Ivoire</option>
                                <option value="HR">Croatia</option>
                                <option value="CU">Cuba</option>
                                <option value="CB">Curacao</option>
                                <option value="CY">Cyprus</option>
                                <option value="CZ">Czech Republic</option>
                                <option value="DK">Denmark</option>
                                <option value="DJ">Djibouti</option>
                                <option value="DM">Dominica</option>
                                <option value="DO">Dominican Republic</option>
                                <option value="TM">East Timor</option>
                                <option value="EC">Ecuador</option>
                                <option value="EG">Egypt</option>
                                <option value="SV">El Salvador</option>
                                <option value="GQ">Equatorial Guinea</option>
                                <option value="ER">Eritrea</option>
                                <option value="EE">Estonia</option>
                                <option value="ET">Ethiopia</option>
                                <option value="FA">Falkland Islands</option>
                                <option value="FO">Faroe Islands</option>
                                <option value="FJ">Fiji</option>
                                <option value="FI">Finland</option>
                                <option value="FR">France</option>
                                <option value="GF">French Guiana</option>
                                <option value="PF">French Polynesia</option>
                                <option value="FS">French Southern Ter</option>
                                <option value="GA">Gabon</option>
                                <option value="GM">Gambia</option>
                                <option value="GE">Georgia</option>
                                <option value="DE">Germany</option>
                                <option value="GH">Ghana</option>
                                <option value="GI">Gibraltar</option>
                                <option value="GB">Great Britain</option>
                                <option value="GR">Greece</option>
                                <option value="GL">Greenland</option>
                                <option value="GD">Grenada</option>
                                <option value="GP">Guadeloupe</option>
                                <option value="GU">Guam</option>
                                <option value="GT">Guatemala</option>
                                <option value="GN">Guinea</option>
                                <option value="GY">Guyana</option>
                                <option value="HT">Haiti</option>
                                <option value="HW">Hawaii</option>
                                <option value="HN">Honduras</option>
                                <option value="HK">Hong Kong</option>
                                <option value="HU">Hungary</option>
                                <option value="IS">Iceland</option>
                                <option value="IN">India</option>
                                <option value="ID">Indonesia</option>
                                <option value="IA">Iran</option>
                                <option value="IQ">Iraq</option>
                                <option value="IR">Ireland</option>
                                <option value="IM">Isle of Man</option>
                                <option value="IL">Israel</option>
                                <option value="IT">Italy</option>
                                <option value="JM">Jamaica</option>
                                <option value="JP">Japan</option>
                                <option value="JO">Jordan</option>
                                <option value="KZ">Kazakhstan</option>
                                <option value="KE">Kenya</option>
                                <option value="KI">Kiribati</option>
                                <option value="NK">Korea North</option>
                                <option value="KS">Korea South</option>
                                <option value="KW">Kuwait</option>
                                <option value="KG">Kyrgyzstan</option>
                                <option value="LA">Laos</option>
                                <option value="LV">Latvia</option>
                                <option value="LB">Lebanon</option>
                                <option value="LS">Lesotho</option>
                                <option value="LR">Liberia</option>
                                <option value="LY">Libya</option>
                                <option value="LI">Liechtenstein</option>
                                <option value="LT">Lithuania</option>
                                <option value="LU">Luxembourg</option>
                                <option value="MO">Macau</option>
                                <option value="MK">Macedonia</option>
                                <option value="MG">Madagascar</option>
                                <option value="MY">Malaysia</option>
                                <option value="MW">Malawi</option>
                                <option value="MV">Maldives</option>
                                <option value="ML">Mali</option>
                                <option value="MT">Malta</option>
                                <option value="MH">Marshall Islands</option>
                                <option value="MQ">Martinique</option>
                                <option value="MR">Mauritania</option>
                                <option value="MU">Mauritius</option>
                                <option value="ME">Mayotte</option>
                                <option value="MI">Midway Islands</option>
                                <option value="MD">Moldova</option>
                                <option value="MC">Monaco</option>
                                <option value="MN">Mongolia</option>
                                <option value="MS">Montserrat</option>
                                <option value="MA">Morocco</option>
                                <option value="MZ">Mozambique</option>
                                <option value="MM">Myanmar</option>
                                <option value="NA">Nambia</option>
                                <option value="NU">Nauru</option>
                                <option value="NP">Nepal</option>
                                <option value="AN">Netherland Antilles</option>
                                <option value="NL">Netherlands (Holland, Europe)</option>
                                <option value="NV">Nevis</option>
                                <option value="NC">New Caledonia</option>
                                <option value="NZ">New Zealand</option>
                                <option value="NI">Nicaragua</option>
                                <option value="NE">Niger</option>
                                <option value="NG">Nigeria</option>
                                <option value="NW">Niue</option>
                                <option value="NF">Norfolk Island</option>
                                <option value="NO">Norway</option>
                                <option value="OM">Oman</option>
                                <option value="PK">Pakistan</option>
                                <option value="PW">Palau Island</option>
                                <option value="PS">Palestine</option>
                                <option value="PA">Panama</option>
                                <option value="PG">Papua New Guinea</option>
                                <option value="PY">Paraguay</option>
                                <option value="PE">Peru</option>
                                <option value="PH">Philippines</option>
                                <option value="PO">Pitcairn Island</option>
                                <option value="PL">Poland</option>
                                <option value="PT">Portugal</option>
                                <option value="PR">Puerto Rico</option>
                                <option value="QA">Qatar</option>
                                <option value="ME">Republic of Montenegro</option>
                                <option value="RS">Republic of Serbia</option>
                                <option value="RE">Reunion</option>
                                <option value="RO">Romania</option>
                                <option value="RU">Russia</option>
                                <option value="RW">Rwanda</option>
                                <option value="NT">St Barthelemy</option>
                                <option value="EU">St Eustatius</option>
                                <option value="HE">St Helena</option>
                                <option value="KN">St Kitts-Nevis</option>
                                <option value="LC">St Lucia</option>
                                <option value="MB">St Maarten</option>
                                <option value="PM">St Pierre &amp; Miquelon</option>
                                <option value="VC">St Vincent &amp; Grenadines</option>
                                <option value="SP">Saipan</option>
                                <option value="SO">Samoa</option>
                                <option value="AS">Samoa American</option>
                                <option value="SM">San Marino</option>
                                <option value="ST">Sao Tome &amp; Principe</option>
                                <option value="SA">Saudi Arabia</option>
                                <option value="SN">Senegal</option>
                                <option value="SC">Seychelles</option>
                                <option value="SL">Sierra Leone</option>
                                <option value="SG">Singapore</option>
                                <option value="SK">Slovakia</option>
                                <option value="SI">Slovenia</option>
                                <option value="SB">Solomon Islands</option>
                                <option value="OI">Somalia</option>
                                <option value="ZA">South Africa</option>
                                <option value="ES">Spain</option>
                                <option value="LK">Sri Lanka</option>
                                <option value="SD">Sudan</option>
                                <option value="SR">Suriname</option>
                                <option value="SZ">Swaziland</option>
                                <option value="SE">Sweden</option>
                                <option value="CH">Switzerland</option>
                                <option value="SY">Syria</option>
                                <option value="TA">Tahiti</option>
                                <option value="TW">Taiwan</option>
                                <option value="TJ">Tajikistan</option>
                                <option value="TZ">Tanzania</option>
                                <option value="TH">Thailand</option>
                                <option value="TG">Togo</option>
                                <option value="TK">Tokelau</option>
                                <option value="TO">Tonga</option>
                                <option value="TT">Trinidad &amp; Tobago</option>
                                <option value="TN">Tunisia</option>
                                <option value="TR">Turkey</option>
                                <option value="TU">Turkmenistan</option>
                                <option value="TC">Turks &amp; Caicos Is</option>
                                <option value="TV">Tuvalu</option>
                                <option value="UG">Uganda</option>
                                <option value="UA">Ukraine</option>
                                <option value="AE">United Arab Emirates</option>
                                <option value="UY">Uruguay</option>
                                <option value="UZ">Uzbekistan</option>
                                <option value="VU">Vanuatu</option>
                                <option value="VS">Vatican City State</option>
                                <option value="VE">Venezuela</option>
                                <option value="VN">Vietnam</option>
                                <option value="VB">Virgin Islands (Brit)</option>
                                <option value="VA">Virgin Islands (USA)</option>
                                <option value="WK">Wake Island</option>
                                <option value="WF">Wallis &amp; Futana Is</option>
                                <option value="YE">Yemen</option>
                                <option value="ZR">Zaire</option>
                                <option value="ZM">Zambia</option>
                                <option value="ZW">Zimbabwe</option>
                                </select>
                                </p>
                                <p>
                                    <label>Email:</label>
                                    <input type='text' name='email' id="email" />
                                    <span id="emailInfo" class="error">We will not spam you</span>
                                </p>
                                <p>
                                    <label>Age:</label>
                                    <input type='text' name='age' id="age"/>
                                    <span id="ageInfo" class="error">Optional</span>
                                </p>
                                <p>
                                    <label>Phone number:</label>
                                    <input name='telephone' type='text'>
                                    <span class="error">Optional</span>
                                </p>
                                <p>
                                <p class="whyTitle">Why are you drawing your heart?</p>
                                <textarea name='why'></textarea>
                                <span class="error">Optional</span>
                                </p>
                                <p>
                                    <input type="checkbox" name="agreement" id="agree"/> I Agree to the Terms and Conditions
                                    <span id="agreeInfo"></span>
                                </p>
                                <br>
                                <input type='submit' value='Register' id="submitBtn"/>
                                </p>
                                </fieldset>
                                </form>
                            </td>
                        </tr>
                    </table>
                </div>
            </li>
        </ul>
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            <li>
                <a href="footer/1.html" target="_blank">HeartESTEEM</a>&nbsp; |
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                <a href="footer/2.html" target="_blank">HeartESTEEM Gallery</a>&nbsp; |
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            <li>
                <a href="footer/3.html" target="_blank">Gloria Maxx</a>&nbsp; |
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            <li>
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            <li>
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            <li>
                <a href="footer/6.html" target="_blank">HeartIZTS</a>&nbsp; |
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            <li>
                <a href="footer/7.html" target="_blank">HeartPILLARS</a>&nbsp; |
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            <li>
                <a href="footer/8.html" target="_blank">Terms and Privacy</a>&nbsp; |
            </li>
            <li>
                <a href="footer/9.html" target="_blank">Trademarks</a>&nbsp; |
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            <li>
                <a href="footer/10.html" target="_blank">Contact</a>
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